Healthcare Provider Details

I. General information

NPI: 1093767832
Provider Name (Legal Business Name): RHONDA E. LAW PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. RHONDA E. CARLSON

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 01/15/2020
Certification Date: 01/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1880 POTTERY AVE SUITE 100
PORT ORCHARD WA
98366
US

IV. Provider business mailing address

4300 LAKE HELENA ROAD
PORT ORCHARD WA
98367
US

V. Phone/Fax

Practice location:
  • Phone: 360-895-9090
  • Fax: 360-895-9089
Mailing address:
  • Phone: 360-895-4017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00003991
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: